Feasibility of laparoscopic tumour nephrectomy in children
| Autor: | Michael Jackson, Rishi Ramaesh, Anna Cv Harris, Ewan M. Brownlee, Fraser D. Munro, Gordon A. MacKinlay |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Databases Factual medicine.medical_treatment Nephrectomy 03 medical and health sciences 0302 clinical medicine 030225 pediatrics medicine Humans Child Retrospective Studies business.industry Significant difference Infant Newborn Infant General Medicine Kidney Neoplasms Surgery Open group Treatment Outcome medicine.anatomical_structure Tumour size Child Preschool 030220 oncology & carcinogenesis Contralateral kidney Pediatrics Perinatology and Child Health Feasibility Studies Abdomen Female Laparoscopy business Follow-Up Studies |
| Zdroj: | Journal of Pediatric Surgery. 53:302-305 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2017.11.032 |
| Popis: | The laparoscopic approach to tumour nephrectomy in children is controversial. We therefore reviewed our institution's cases of tumour nephrectomy (laparoscopic, open, and converted) to better understand which is suitable for this approach, what factors prevent it, and whether one can excise tumours greater than the CCLG recommendation of 300 ml.All tumour nephrectomies performed between 2002 and 2016 were identified using our surgical database. Further data were gathered from radiology and pathology databases. Those with nonrenal tumours or having a partial nephrectomy were excluded. Tumour maximum diameters, volumes, and ratios to contralateral kidneys were calculated. A Mann-Whitney U was used to compare the groups.Forty-three cases were included. Fifteen procedures were completed laparoscopically (35%), and a further 3 converted. The median age at surgery was 2.5 years (range 0-10) in the laparoscopic group and 2 years (range 0-15) in the open group. There was a significant difference (P0.05) between the laparoscopic and open groups for: median maximum diameter (10cm vs 12.25cm), median volume (155 ml vs 459 ml), maximum diameter ratio (1.22 vs 1.75), and volume ratio (3.8 vs 11.2).Tumours in the laparoscopic group were significantly smaller, but it was possible to excise tumours more than 300 ml. Difficulties in excision related to tumour size relative to the abdomen. Therefore, a ratio of tumour to contralateral kidney may be a better guide to safe excision than an overall volume cutoff. From our series, the laparoscopic approach is likely to be achievable if the volume ratio is ≤ 8.1.Level 3. |
| Databáze: | OpenAIRE |
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